Manual despre Prevenirea si Tratarea Infectiei cu COVID-19

28 Handbook of COVID-19 Prevention and Treatment
2 Lung Recruitment
Lung recruitment improves the heterogeneous distribution of lesions in patients with
ARDS. However, it may result in severe respiratory and circulatory complications and
therefore, the lung recruitment maneuver is not routinely recommended. The assessment
of lung expandability should be performed prior to the application.
(3) Prone Position Ventilation
Most critically ill patients with COVID-19 respond well to prone ventilation, with a rapid
improvement of oxygenation and lung mechanics. Prone ventilation is recommended as
a routine strategy for patients with PaO 2
/FiO 2
< 150 mmHg or with obvious imaging
manifestations without contraindications. Time course recommended for prone
ventilation is more than 16 hours each time. The prone ventilation can be ceased once
PaO 2
/FiO 2
is greater than 150 mmHg for more than 4 hours in the supine position.
Prone ventilation while awake may be attempted for patients who have not been
intubated or have no obvious respiratory distress but with impaired oxygenation or have
consolidation in gravity-dependent lung zones on lung images. Procedures for at least 4
hours each time is recommended. Prone position can be considered several times per
day depending on the effects and tolerance.
(4) Prevention of Regurgitation and Aspiration
Gastric residual volume and gastrointestinal function should be routinely evaluated.
Appropriate enteral nutrition is recommended to be given as earlier as possible.
Nasointestinal feeding and continuous nasogastric decompression are recommended.
Enteral nutrition should be suspended and aspiration with 50 mL syringe be done before
transfer. If no contraindication exists, a 30° semi-sitting position is recommended.
(5) Fluid Management
Excessive fluid burden worsens hypoxemia in COVID-19 patients. To reduce pulmonary
exudation and improve oxygenation, the amount of fluid should be strictly controlled
while ensuring the patient's perfusion.
(6) Strategies to Prevent Ventilator-Associated Pneumonia (VAP)
VAP bundled strategies should be strictly implemented:
1 Select appropriate type of endotracheal tube;
2 Use a endotracheal tube with subglottic suction (once every 2 hours, aspirated with 20
mL empty syringe each time);
3 Place the endotracheal tube at the right position and correct depth, fix properly and
avoid pulling;